Dry Eyes Treatments Newport Beach

The Outside-In Approach to Dry Eye
THE OCULOPLASTIC PERSPECTIVE

An often overlooked element of dry eye is the effect that the structure and function of our eyelids contributes to the comfort and health of our eyes. With each blink the eyelids contribute a complex of needed functions to maintain the health of our ocular surface.

Dr. Joseph offers a very unique perspective on Dry Eye Syndrome, based on his specialized training and focus on the eyelids.

I already take eye drops for my dry eyes. How is this different?

Classically, treatment for dry eye relied on adding external moisture to the eyes in the form of eyedrops. These artificial tear drops are used to lubricate the ocular surface and are used periodically during the day or during times of extreme dryness. While these drops can be an important addition in the treatment of your dry eye, there are a lot of issues with using these drops as a primary treatment. First, and foremost, they are not treating the problem, they are merely trying to mask it. Also, for a lot of people they just do not work well enough. Taking a few drops per day doesn’t make up for the dry gritty feeling you feel with each of your many thousands of blinks each day.

I have heard about prescriptions eye drops for dry eye? Can Restasis help my dry eye?

Restasis is a heavily advertised prescription medication for dry eye. It is meant to increase tear production in a certain subset of patients who have decreased tear production due to inflammation of the ocular surface. While this may be a very helpful medication for some, it is less helpful for others. A consultation with Dr. Joseph in his Newport Beach office will help determine the underlying cause of your dry eye and which treatment is right for you.

My eyes tear a lot, can I have dry eye?

Surprisingly, the most common cause of excessive tearing is actually excessive dryness of the eyes. Tearing occurs as a response to the irritation and damage that accumulates due to this dryness. If you experience occasional irritation, or a sandy or gritty feeling on the eyes then you may have an element of dry eye. Also, if you’re tearing seems to occur at certain times of the day, in certain locations, with certain weather conditions, or with certain activities then this may be a sign that dryness is to blame.

Why are the eyelids so important?

While the production and amount of tears is important in the maintenance of the surface of the eye. It is in only one part of a very complex interaction of factors that determines whether or not our eyes are dry and irritated or lubricated and comfortable.

The Tear Film – The tears produced from our tear glands are only ⅓ of the tear film. Just as important is the oil made from glands in the eyelids called Meibomian Glands. This oil stabilizes the tear film and allows it to spread and evenly coat the surface of the eye.

Inflammation – The most common reason for poorly functioning meibomian glands is inflammation of the eyelids called blepharitis. This inflammation is exceedingly common and is present in the vast majority of dry eye patients seen by Dr. Joseph. It is also poorly controlled in many of these patients which propagates their dry eye symptoms despite using lubricating eye drops consistently.

Eyelid Structure and Function – The dependence we have on the eyelids for the health and comfort of our eyes is evident with each blink. If you try to go an extra few seconds without blinking your eye will immediately let you know how unhappy it is. If the eyelids do not rest in the appropriate position and with the appropriate tension in relation to the eye; or if closure or blinking is abnormal or incomplete, this can lead to very severe dry eye disease.

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What causes blepharitis?

Despite being very common in general, each case of blepharitis is unique in its cause and characteristics. Potential causes include:

Bacterial sensitivity or overgrowth

Rosacea

Age or hormone related changes to meibomian gland secretions

Follicular mites such as Demodex.

Seborrheic dermatitis

Allergic or hypersensitivty mediated eyelid inflammation

Successful treatment of blepharitis is dependent on successful identification of the cause or causes that are contributing to the problem. Dr. Joseph, as an oculoplastic and eyelid specialist focuses his practice on the eyelids. It is this focus that allows for successful diagnosis and treatment of your blepharitis.

How do I know what is causing my dry eye?

This is where the knowledge, experience, and cutting edge technology Dr. Joseph provides come together.

The first step is a visit with Dr. Joseph in his Orange County office. He will have you describe your symptoms and evaluate your eyes under the microscope to determine if your eyelids are contributing to your dry eye.

In certain patients further evaluation is needed. The newest technology in dry eye assessment is the Lipiview. Dr. Joseph offers this cutting edge tool in dry eye assessment in conjunction with UC Irvine Department of Ophthalmology and The Gavin Herbert Eye Institute where Dr. Joseph is currently an assistant clinical professor.

What eyelid focused treatment options are available for blepharitis and dry eye disease?

It is clear that a large portion of dry eye can be related to eyelid specific issues. As an oculoplastic and eyelid specialist, Dr. Joseph offers the newest advances in both minimally invasive and surgical treatments to address all potential eyelid contributions to dry eye.

BlephEx – This new device approaches the debris (called a biofilm) that collects on the eyelid edge in patients with blepharitis in a very novel way. A precise microsponge debrider is used to clean the lashes and eyelid edge of this biofilm. This biofilm, if left untreated leads to a cycle of inflammation, meibomian gland dysfunction, poor oil production, tear film instability, and dry eyes.

Punctal Plugs – These temporary and safe silicone plugs hold extra tears on the surface of the eye, effectively increasing the amount of tears available to the eye at any given time.

LipiFlow – For the vast majority of patients whose dry eye is not a result of underproduction of tears, but of poor oil production. Uses patented and state of the art technology using precisely controlled heat applied to the inner eyelid with adaptive, pulsating pressure. This opens and clears blocked meibomian glands and allows them to resume natural production needed for a healthy tear film.

Intense Pulsed Light (IPL) – This treatment is FDA approved for rosacea. Now used in a new way, it is proving successful in treating the inflammatory component of blepharitis and dry eye. Using high intensity light, blood vessels which are dilated and contribute to inflammation are narrowed. This decreases the inflammatory signals to the lids and glands allowing them to function normally. An added benefit is that the IPL has an antibacterial effect, decreasing the amount of bacteria living on the eyelid causing reactive inflammation. IPL can even decrease the amount of demodex mites on the lid edge, which can cause significant eyelid inflammation or blepharitis.

Eyelid retraction repair – Eyelid retraction refers to eyelids that rest too low in relation to the surface of the eye. Causes include:

Loosening of eyelid tissues as a normal aging process

Scarring from prior surgery

skin cancer reconstruction

lower eyelid blepharoplasty

Decreased eyelid muscle tone and strength

facial nerve (Bell’s) palsy

prior cosmetic eyelid surgery

Loss or descent of midfacial volume

Depending on the cause of retraction, treatment can include in office treatment such as volumizing filler, or surgical repair.

If you struggle with dry eye, or if you are constantly using eyedrops to keep your eyes comfortable, there may be a better solution. Your eyelids may be contributing to or causing your dry eyes. A consultation with Dr. Joseph in his Orange County office is the first step to improving your eyes.

Consultation

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"Dr Joseph made me feel like I was his only patient. He asked me what my concerns were and how he felt he could address them to make me happy. He took the time to explain the products available, what he felt would work for my concerns and how the procedure works. He talked me through the process always making sure I was comfortable."